President's Message

January 2021

Vaccines and Vaccination

Dear Maryland ACC Colleagues,

Happy New Year to everyone. I hope that you all had some restful time to spend with family (and perhaps a few friends in your bubble).

I spent some of my time off a few days ago reading the results of the Moderna Covid vaccine trial, published December 30 in the New England Journal of Medicine. As many of you may know, this is one of the two vaccines based on mRNA encoding the spike protein of SARS-CoV2. The results are striking and show that the vaccine was successful beyond all expectations. In 30,240 volunteers, the vaccine reduced any symptomatic Covid-19 illness by 94% (185 cases in placebo group, 11 cases in vaccine group). Even more impressive, severe Covid-19 illness occurred only in the placebo group (30 cases) and not in any of the vaccinated volunteers. Vaccine efficacy appeared similar in all important subgroups. Similar results were previously reported with the Pfizer mRNA vaccine. While these studies could not conclude whether vaccination reduces asymptomatic infection and spread, the results clearly suggest that widespread vaccination could dramatically reduce hospitalizations and deaths from Covid-19.

As others have observed, vaccines will not alter the trajectory of the Covid pandemic – only vaccination will. And, as many in the lay press and social media have noted, the U.S. is off to a slow start. The State of Maryland, similar to other states, has vaccinated less than 1% of its population as of January 1. In contrast, Israel has already vaccinated 10% of its population. Maryland has appropriately prioritized nursing home residents and health care workers, following CDC guidance. You can track the state’s progress in vaccination here.

Many are already expressing concern about the slow pace of vaccination roll out and the seeming lack of urgency and preparedness. Currently, 2,000-3,000 American residents are dying of Covid-19 daily, hospitals in hot zones have had to curtail elective medical and surgical procedures, thousands of businesses are closing, 800,000 workers are added to unemployment rolls monthly, and tens of millions of children have been out of school since last March. What is clearly needed is a Manhattan Project-level urgency and prioritization to speed our way out of this disaster.

What can we as cardiovascular professionals do to help?

• Learn everything you can about the safety and efficacy of the vaccine as the information is published in the scientific literature. Being knowledgeable will help you to recommend the vaccine confidently to others.

• Get vaccinated when you are offered the opportunity to do so. While it is arguable whether all health care workers should have been in the first wave, we do set an example for others by getting vaccinated and we will help to break the chain of transmission as much as anyone else. I am scheduled this Thursday!

• Encourage your patients to get vaccinated whenever they have an opportunity to do so with every patient encounter. Tell them about your vaccination experience to reassure them. I was strongly encouraging the influenza shot in the fall and will be promoting the Covid vaccines this winter. You can also direct patients to helpful information on CardioSmart.

• Urge leaders in your health system to pressure government officials to accelerate the roll out and ensure that vaccines are going into arms as fast as they are received from the federal government. While the feds could be doing more, the last-mile-into-arms problem will inevitably fall to the states and local health systems, and our Maryland government officials need to be held accountable for delivering results. In addition, ask what your health system is doing to help with the effort.

• Contact your Maryland State representatives and/or Governor Hogan directly to express your concern if the pace of vaccination does not improve.

• Look for opportunities to volunteer to help in the effort. The state did this with the Convention Center field hospital and could do something similar with vaccination.

To see what is possible, read this fascinating article covering how New York City vaccinated six million people in one month against smallpox to stem an outbreak – in 1947!

2021 will start the process of digging out from the pandemic and its collateral damage. The work is going to be substantial at all levels, but I believe we will have much to look forward to in the New Year. I look forward to working with all of you, my ACC cardiovascular professional colleagues, to do our part.

As always, please send MDACC leadership and staff your comments, questions, ideas, and suggestions to president@marylandacc.org.

Joseph E. Marine, MD, FACC